New Enquiry Information for 1:1 Diet with Debs

New Enquiry

One2One Diet With Maxine
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Please answer the questions so that I can best help you achieve your goals.
Name

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Address

Street Address

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Date of Birth

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Lifestyle and Medical

These answers help me to recommend the best plan for your journey
Please Enter your Height
Please enter your approximate Weight
What is your goal weight / size?
Please enter your waist measurement
Your Occupation
Please indicate your level of Activity
Do you take any prescribed medication at all? If so please give names and dosage.
Do you have any ongoing medical conditions? If so, please give details
Do you have any allergies or intolerances? If so, please give details
Have you had any general accidents or any surgery in the last 3 months?
Women only: Are you pregnant/ have you given birth in the last 3 months?
Women only: are you currently breastfeeding?
NOTE: The 1:1 Diet by Cambridge Weight Plan is NOT appropriate for those who are alcoholic, substance misusers, underweight, pregnant, breastfeeding, or who have given birth in the last 3 months, and those younger than 14 years.
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New Enquiry

A little bit about you

Lifestyle and Medical